“Supported by a rich cultural heritage, the Haitian people retain a capacity for hope, faith, and resilience that remains a tremendous resource for any efforts to rehabilitate the nation and its people” (p. xxiv) writes Erica James in the preface to her book, Democratic insecurities: Violence, Trauma, and Intervention in Haiti. This statement should accompany the reader through the book’s seven chapters, which are saturated with descriptions of violence and suffering, in order to keep the reader’s focus on the ways in which individuals and families targeted for repression “formulate new political subjectivities” as military and humanitarian apparatuses intervene in their lives.

James traces the multiple links between terror and compassion that have shaped Haiti’s struggle to strengthen its democracy and fight insecurity during and after the country’s coup in 1991. In so doing, she focuses on the paradox inherent in: (a) the way “compassion economies” work by promoting democracy, economic growth and individual rehabilitation while, at the same time, corrupting and repressing that which they intended to repair, and (b) the way individuals and institutional and government actors perceive, make sense of and navigate these seemingly hidden and occult powers through mutual aid and solidarity as well as competition, corruption and violence.

James conducted multi-sited ethnographic fieldwork and worked as a therapeutic practitioner in Haiti for 27 months between 1995 and 2000. For her fieldwork she drew on a variety of research methods: she accompanied and interviewed victims of human rights abuses in their search for justice, healing and reparations from aid organizations; she worked with victims as a therapeutic practitioner employing the “Trager Approach” at a privately funded women’s clinic; she provided consulting services for the America’s Development Foundation (ADF); she conducted archival research and conducted participant observation at the ADF Human Rights Fund (HRF); and she studied with Haitian mental health practitioners in outpatient therapy sessions at the State University Hospital. In her book, James masterfully connects the different field sites, ethnographic data, archival documents and news reports, and professional experiences while, at the same time, recognizing and reflecting on the situatedness of her knowledge and the challenges of “circumstantial activism.”

In Haiti, terror and compassion are linked by the “political economy of trauma”; the process through which “the suffering from another person, when extracted, transformed and commodified through maleficent and beneficent interventions, can become a profit for the intervener” (p.26). However, while the commodification of suffering is a defining aspect of both the “terror economies” and the “compassion economies,” they pursue opposite goals. In the first chapter, “The Terror Apparatus”, James provides insight into the workings of “terror economies” and the ways in which pervasive “ensekirite” (insecurity) is created through “necropolitical” violence; the “forms of conflict or warfare that deploy torture against populations to inculcate terror and to subjugate life itself to the power of death” (p. 43). In Haiti necropolitical violence is perpetrated to destroy human bodies, entire populations and their culture through the violation of taboos such as rape and incest. Although ghastly, its consequences remain largely hidden, especially when they intersect with forms of biopower and biopolitics that are exerted by powerful national and international actors.

Necropolitical violence was especially flagrant during the coup years between 1991 and 1994 when it was directed at pro-democracy militants and their families. The military regime deprived these individuals of their livelihoods by terrorizing their neighbourhoods, torturing and raping the men and women, and looting and destroying their homes and businesses. These violations did not receive much attention until international humanitarian and development actors disseminated press releases, the exiled Aristide government issued statements to alert the international community, and when Haitian doctors, human rights groups, women’s organizations, and religious organizations began to document the violent outbursts. Despite this evidence, American diplomats and the U.S. government continued to deny the violence by framing it as a cultural attribute and stereotyping sexual violence as normative among Haitians.

According to James, the cruelty exerted by both Haitian and international actors is connected to a history of repression and exploitation. She traces military intervention and violence targeting civilian populations back to the U.S. occupation of Haiti between 1915 and 1934. These colonial political and economic interventions had the result of significantly altering kinship and gender relations and of displacing entire populations from their land, which was subsequently sold to US companies. These interventions forced men to abandon their families in search of work elsewhere, and transformed Haiti into an export economy dependent on US economic imports and interventions. Moreover, US forces themselves committed atrocities. They tortured Haitians with fire, raped women, executed children, and destroyed crops, mills and homes. The brutality was exacerbated when Duvalier took power and involved the Haitian army, paramilitary networks, and several Vodou clerics and civilians in the exploitation, control and destruction of individual and collective bodies. Collectively, they killed more than 60 000 people, tortured, and manipulated Haitian Vodou beliefs, kinship practices, and the sex and gender system. In the 1980s, popular resistance grew when Aristide joined the democratic movement and was elected president in 1990. Yet, his rule was short and only eight months later the Haitian military had already expelled him, taken control of the media and exposed his followers to extreme violence. In order to prevent men from carrying out their gender roles, working and providing for their families, their hands were severed, while women were targeted for their political activism in ways that harmed their productive and reproductive capacity. James’ interview extracts with survivors of such necropolitical acts illustrate how the ultimate aim of these abuses “go beyond the initial attempt to extract legitimacy and power from victims” to enforce “a state of social death and ‘natal alienation’” (p. 79).

The second chapter, “The Aid Apparatus and the Politics of Victimization”, describes the “compassion economy” that developed in Haiti once the American government could no longer turn a blind eye on the atrocities being committed in Haiti and when the U.S.-led Multinational Force entered the country to “restore peace and constitutional order.” In tow were a large number of humanitarian organizations that began to identify the calamities and publish accounts of these “across the globe to generate a sense of urgency in consumers of these materials” (p. 81) and to instil in them the desire to provoke individual, institutional and governmental responses. As a result, in a very short period of time, funds were generated, distributed and managed according to “neomodernist doctrines of civility, governance, rights, and rationality” (p. 89) in order to provide aid to individuals who could prove that they had suffered at the hands of the Haitian government, military and paramilitary forces. To prove their eligibility for aid, potential recipients had to create “trauma portfolios” consisting of testimonies, pictures, medical records, and witness reports and present them to interventionists for further investigation.

James defines these aid practices as “bureaucraft,” characterized by aspects of both bureaucracy and witchcraft. That is, while bureaucratic diagnostic procedures were able to reinforce individual and institutional security, they also generated mistrust, rumors, speculation and gossip, scandals, competition and, last but not least, accusations of malevolent witchcraft, all of which were due to a lack of transparency in the ways that donors handled the scarce resources. To illustrate the practices and consequences of “bureaucraft,” James describes the internal organization and workings of local human rights and medical organizations and U.S.-funded political development programs. While each of the organizations was required to generate “technologies of trauma” to recognize, categorize and authenticate the testimonies of “viktim” (victims), U.S.-sponsored institutions like the ADF (America’s Development Foundation) Human Rights Fund were also involved in exporting democracy in “hidden or covert ways.” Due to the double mandate and problems of transparency, these organizations lacked credibility with both the Haitian and international human rights communities, while they were also being sought for their services for viktim, such as the provision of medical care and trauma counseling, temporary housing, safe haven and subsistence allowances, legal aid, asylum advice, and prison monitoring.

The ways in which aid recipients encountered the “aid apparatus” is described in the third chapter, “Routines of Rupture and Spaces of (In)Security.” Viktim of violence suffered psychosocial trauma due to the direct consequences of political and interpersonal violence, as well as “routines of rupture” that is, indirect, ongoing structural violence and daily stressors. Within an environment of profound insecurity, James was able to discern temporary “spaces of security” where viktim could give a traumatic testimony before witnesses and found some degree of physical and emotional healing, reparation and political recognition. For example, women’s rights groups organized workshops for women who had been raped and later abandoned by their husbands in order to provide these women with a better understanding of the Haitian legal system and a secure space to voice the violence, betrayal, rejection, vulnerability and loss they had experienced.

A more private “space of security” was the Chanm Fanm clinic located in the poor and violent neighbourhoods of Martissant. Here James worked as a therapist to provide healing employing the “Trager Approach,” a mind-body approach to movement education. She was able to create a space for women to relax, feel and talk about their suffering which they embodied in gendered socially and culturally resonant ways. The local idioms of distress of full body pain, van (wind) and gaz (gas) extended beyond the material and temporal boundaries of the “discrete corporeal individual to the environment – both physical and metaphysical – and to ascending and descending kinship and spiritual networks” (p. 151). Their stories and embodied expressions of distress led James to question the concept of post-traumatic stress disorder as there seemed to be no “post” to their trauma, but rather ongoing violation.

Yet, the flow of resources for emotional and material recovery was not unproblematic. In the fourth chapter, “Double Binds in Audit Cultures”, James describes the audit culture, which characterizes the “grant economy”. Institutions that receive grants perform services for third parties, according to expectation of donors. Although the flow of resources is usually unidirectional, recipients of aid are expected to produce “outputs” while, at the same time, demonstrate a continued demand for support. This balancing act was crucial if recipients were to remain competitive for scarce resources, but it was also often suspected of being manipulated, which then resulted in accusations of witchcraft and bureaucraft.

The high expectations and insecurities led to conflicts between a number of organizations including the ADF, the Human Rights Fund and HSAID/Haiti particularly with regard to the “best way to implement the results packages when working with traumatized communities and individual viktim” (p. 189). To enable effective and transparent work, the Human Rights Fund defined the concept of “victim” narrowly to serve primarily victims of human rights violations and not those of interpersonal violence or ongoing insecurity. To verify a victim’s status and to give him or her access to a network of Haitian and international caregivers, victims had to undergo a number of interviews, provide supporting documentation and/or invite witnesses to testify for them. While seemingly straightforward practices, they were subject to doubt as multiple actors sought to ensure their security and demonstrate accountability and competence. This often resulted in the exploitation and commodification of suffering. For example, when the Human Rights Fund intervened in the capsizing of the Fierte Gonavienne ferry, it proved its competence through professional, bureaucratic practices which were not always in line with the way suffering was experienced by the survivors and the families of dead and missing individuals. At the same time, some individuals tried to profit from the “emerging compassion economy” by falsifying their victim status or, as in the case of funeral home directors, raising the prices for storing bodies and for funeral services.

In the fifth chapter, “Bureaucraft, Accusation, and the Social Life of Aid”, James continues to explore the contested nature of the “victim identity” as well as notions of democracy, rights and security from the Human Rights Fund to Martissant. First, she describes the tensions, disputes and competition for scarce resources between the Human Rights Fund and the civil society project called ASOSYE. “Just as witchcraft accusations arising between closely related actors over the causes of fortune and misfortune can lead to retributive attacks” (p. 230), the actors involved in the two warring projects tried to damage each others reputation by spreading gossip and rumours of mismanagement, nepotism and corruption.

Interestingly, these practices paralleled the “hidden strategies and tactics” employed by viktim to increase the flow of aid such as obtaining membership in several advocacy groups at the same time. Viktim were often frustrated with the bureaucratic practices that limited their access to aid and at times, these frustrations turned violent. For example, sometimes viktim took matters into their own hands to address the perceived injustices by attacking the staff of the Rehabilitation Program. As can be imagined, the random attacks of violence added to the frustration and nervousness of the staff, who started to speculate and suspect the involvement of occult actors in “orchestrating efforts to sabotage the institution and its staff members.”

The sixth chapter, “Sovereign Rule, Ensekirite, and Death” describes the processes that led to the closure of the Rehabilitation Program in relation to multiple attacks against on the ADF, the Human Rights Fund and the Rehabilitation Program staff members. When the attacks increased and fear and insecurity culminated, the Rehabilitation Program felt impelled to increase its security by hiring uniformed guards and providing the staff members with walkie-talkies. Unintentionally, these measures only aggravated the relationship between the organization, the viktim and the associations they represent. Not only did viktim feel treated as second class citizens, but they were reminded of the traumas they had endured at the hands of the military and paramilitary forces – that is, the underlying reasons for their suffering and for their right to receive healing, material aid, education and advocacy. A spiral of hate, physical attacks and murder was unleashed, which resulted in the closure of aid organizations and programs. James argues that the ADF Human Rights Fund Victim Assistance and Rehabilitation Program failed due to the double-binds involving competing local, national and international demands.

In the final chapter, “The Tyranny of the Gift”, James highlights the complex interconnections between the different levels of bureaucraft, the related occult economies and moral contests as well as the disputes related to narratives of trauma, reoccurring psychological wounds and healing strategies. In doing so, she points to several lessons that can be learned from her insight and experience in Haiti. She writes that: (1) it is important to realise that humanitarian aid interventions are multilayered ranging from “covert interference undermining the state to overt intercession to heal its beleaguered citizens” (p. 289). In addition, aid interventions assume a liminal position in that they transcend international, national and local spaces which allow them to be flexible to the ever changing realities on the ground but also add to insecurity, misrepresentation and misunderstandings; (2) there is a need to better coordinate the various aid organizations as little agreement seems to exist about how to best provide essential aid and the differences in therapeutic approaches are overstated; (3) agencies and agents promoting aid must carefully consider how to address the “psychosocial routines of rupture” by situating them in larger political, economic and historical contexts that have shaped notions of violence and insecurity for decades; (4) aid providers have to be aware of the fact that aid can produce unintentional consequences that may exacerbate existing social, economic and political tensions; and finally, (5) the creation of standardized trauma portfolios may be practical on a bureaucratic level, but may erase the complexity of “local moral worlds”. It is crucial to recognize that actors are embedded in complex fields of power relations which can be benevolent and/or malevolent.

James has written a remarkable and well-researched ethnography that intertwines issues related to violence, trauma-related health problems and humanitarian aid with complex social, political, economic and historical developments in Haiti. Her account is both brave and unsettling, as she questions our taken-for-granted categories such as perpetrators and victims, terror and aid, security and insecurity, bureaucracy and witchcraft, and the benevolence of aid. Yet, by contextualizing these concepts in local realities, James is able to provide profound insight into the lives of people who live with and navigate these ambiguities on a daily basis. The account is honest and transparent because James situates herself and her work as a therapist in the field of humanitarian aid and does not shy away from spelling out her own involvement in the “compassion economy” and the commodification of suffering.

Although the ethnographic findings and the related recommendations are based on research that was conducted between the mid 1990s until 2000, they are more important than ever. When the devastating earth quake hit Haiti in 2010 and killed, injured and displaced hundreds of thousands of people, international military forces, UN agencies and non-governmental organizations poured into the country to provide first aid, shelter, clean water and food, administer operations, medication, and psychosocial counselling, restore security, promote democracy, and so on. Problems related to the lack of coordination and inappropriate trauma work have been widely reported and are partly related to the fact that most of the staff in these institutions is ignorant of Haiti’s history; its cultural, social, political and economic systems; its former and current power structure; and its health care system. To keep history from repeating itself, James’ book is not only instructive for anthropologists interested in military and humanitarian interventions in complex emergencies, but also for humanitarian aid providers who momentarily work or are planning to work in Haiti.

Hanna Kienzler completed her PhD in medical anthropology at the Departments of Anthropology and Social Studies of Medicine at McGill University in 2010. Currently, she is a Postdoctoral Fellow funded by the Strategic Training Program in Global Health Research, a partnership of the Canadian Institutes of Health Research and the Québec Population Health Research Network and works at the Department of Psychiatry and the Psychosocial Research Division at the Douglas Mental Health University Institute at McGill University. Hanna Kienzler has a long-standing academic interest in the field of war-trauma and global health, in connection with organized violence, ethnic conflict and complex emergencies, and their mental health outcomes. Within this broad field of enquiry, she is particularly interested in the social determinants of health and illness, gender based violence, trauma, PTSD, local idioms of distress, resilience, and local forms of healing as well as in the growing field of human rights and humanitarian and clinical interventions. Hanna Kienzler has conducted ethnographic research in Kosova, in Hutterite colonies in Canada and the US, and in Kyrgyzstan.